Inhalers for asthma without steroids

Nebulisers are machines that turn the liquid form of your short-acting bronchodilator medicines into a fine mist, like an aerosol. You breathe this in with a face mask or a mouthpiece. Nebulisers are no more effective than normal inhalers. However, they are extremely useful in people who are very tired (fatigued) with their breathing, or in people who are very breathless. Nebulisers are used mainly in hospital for severe attacks of asthma when large doses of inhaled medicines are needed. They are used less commonly than in the past, as modern spacer devices are usually just as good as nebulisers for giving large doses of inhaled medicines. You do not need any co-ordination to use a nebuliser - you just breathe in and out, and you will breathe in the medicine.

Pre-pregnancy, it is important to optimise control of your asthma. During pregnancy you should be closely monitored so that appropriate changes to treatment can be quickly implemented in response to any changed symptoms. In general, asthma inhalers are believed to be safe in pregnancy and the risk of harm to the foetus is much greater from having undertreated and poorly controlled asthma. Roughly one third of women find that their asthma improves during pregnancy, one third find that it stays the same, and the final third find that it worsens.

Work-related Asthma or Occupational Asthma
• An estimated million cases of asthma among adults were work-related, accounting for % of current adult asthma cases. 8
• Work-related asthma significantly differs by age and is highest among persons aged 45–64 years (%). 8

Asthma and Influenza
• Among the 830 influenza-related pediatric deaths between 2004 and 2012, 16% of the subjects had asthma. 9
• Between 2003 and 2009, 32% of the 2165 children hospitalized for seasonal influenza had asthma. 10
• 44% of 1160 children hospitalized for pandemic H1N1 infection had asthma. Children with asthma had four times higher odds of pandemic H1N1 infection than non-asthmatic children and were hospitalized at significantly higher rates than prior influenza seasons. 10
• The CDC recommends universal, annual vaccination to reduce influenza-related mortality and curb viral transmission. This includes young children, adults older than 65, and those with high-risk medical conditions, (. asthma) who are at the highest risk for complications of influenza infection. Subjects with underlying cardiopulmonary complications like asthma are at risk of pneumonia, bronchiolitis, sepsis and secondary bacterial infection from influenza. 11

Asthma and Obesity
• In 2011-2014, current asthma prevalence was % among all adults. During this time period, asthma was more common among adults with obesity (%) compared with adults in normal weight (%) and overweight (%) categories. 12
• Women with obesity were more likely to have asthma than those in lower weight categories. Overall, women with obesity had higher current asthma prevalence (%) compared with women in the normal weight (%) and overweight (%) categories. 12
• Among adults aged 60 and over, there was a significant trend of increasing asthma prevalence with weight status: % among normal weight adults; % among overweight adults; % among adults with obesity. 12
• Among weight status subgroups, current asthma prevalence increased from % in 2001-2012 to % in 2013-2014 among adults in the overweight category. 12

Monoamine oxidase inhibitors (phenelzine, isocarboxazid), clonidine , selegiline , guanethidine, and ergotamines (ergotamine tartrate, dihydroergotamine mesylate) may increase blood pressure when used at the same time as ephedrine. Methyldopa or reserpine may reduce ephedrine levels in the blood and thereby lessen the effectiveness of ephedrine. Tricyclic antidepressants ( desipramine , amitriptyline , doxepin , and imipramine ) may block the effect of ephedrine. The carbonic anhydrase inhibitors acetazolamide and dichlorphenamide may increase ephedrine blood levels and the risk of side effects from ephedrine. Patients taking any medications should consult with their physician or pharmacist before starting OTC ephedrine.

A neb treatment has 2500 mcg of Albuterol, while two puffs of an MDI is 200 mcg of the same medicine. The increase in heart rate often noted with the neb reflects the higher dose. So how do we explain the often reported similar subjective and lung response in patients regardless of delivery method ? I’m not sure, but I wonder if the neb dose could be lowered without sacrificing response for those instances where the MDI is effective. Or approach nebs like we do with an MDI: start with 500 – 1000 mcg, and if desired take a second treatment.

Inhalers for asthma without steroids

Monoamine oxidase inhibitors (phenelzine, isocarboxazid), clonidine , selegiline , guanethidine, and ergotamines (ergotamine tartrate, dihydroergotamine mesylate) may increase blood pressure when used at the same time as ephedrine. Methyldopa or reserpine may reduce ephedrine levels in the blood and thereby lessen the effectiveness of ephedrine. Tricyclic antidepressants ( desipramine , amitriptyline , doxepin , and imipramine ) may block the effect of ephedrine. The carbonic anhydrase inhibitors acetazolamide and dichlorphenamide may increase ephedrine blood levels and the risk of side effects from ephedrine. Patients taking any medications should consult with their physician or pharmacist before starting OTC ephedrine.